Provider Demographics
NPI:1972554095
Name:DINGLASAN, JOEL R (PT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:DINGLASAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1057
Mailing Address - Country:US
Mailing Address - Phone:212-534-5778
Mailing Address - Fax:212-534-9397
Practice Address - Street 1:115 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1057
Practice Address - Country:US
Practice Address - Phone:917-803-7870
Practice Address - Fax:212-534-9397
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ18V61Medicare PIN